Estimation of alcohol and nicotine consumption in 11 cities of Turkey using wastewater‐based epidemiology

Abstract

Alcohol and tobacco are the most frequently consumed substances in the world.Both are significantly associated with the increasing number of different diseases.Thus, monitoring nicotine and alcohol use is vital for public health planning and intervention strategies. This study aimed to calculate estimates of alcohol and nicotine use in 11 cities of Turkey using wastewater-based epidemiology. In 2019, daily composite wastewater samples from 18 wastewater treatment plants were collected for a week per season. The 24-h composite samples were collected via auto-samplers.Sample preparation for wastewater samples collected was done using liquid-liquid extraction and solid-phase extraction. Nicotine and ethyl sulfate (EtS) were analyzed using validated liquid chromatography-tandem mass spectrometry method. The estimated average nicotine consumption was 2.84 mg/p/day, and the average alcohol consumption was 3.46 ± 1.83 ml/p/day. The highest nicotine consumption was observed in Kayseri city; the highest alcohol consumption was calculated for Mersin city. In this study, the cigarette and alcohol consumption estimate obtained by wastewater-based epidemiology (WBE) was found to be higher than the Turkey Tobacco and Alcohol Market Regulatory Authority report. To our knowledge, this study is the most comprehensive one so far applied using WBE for 11 cities in Turkey and evaluates alcohol and nicotine use together.

Identification of biomarkers in wastewater-based epidemiology: Main approaches and analytical methods

“…These reviews categorized biomarkers depending a little bit on the authors criterion but in all cases consumption, exposure, health/disease and lifestyle/consumption are main drivers of these classifications. Studies focus on consumption of mostly illicit drugs [ 19 , 23 , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] ] but also food [ 42 , 43 ], artificial sweeteners [ 44 , 45 ], alcohol [ [46] , [47] , [48] , [49] , [50] , [51] ], caffeine [ 52 , 53 ], nicotine [ 47 , [51] , [52] , [53] ] and/or tobacco [ [54] , [55] , [56] , [57] , [58] ], new psychoactive substances [ 39 , [59] , [60] , [61] , [62] , [63] ], opioids [ 18 , 64 , 65 ], pharmaceuticals [ 22 , 34 , 53 , [66] , [67] , [68] , [69] , [70] , [71] , [72] ] and personal care products [ 34 ] are the most common. These studies are the most elaborated, as especially in the case of drugs of abuse, work has been ongoing since 2005 and there has been a major effort by many research groups to collaborate many times disinterestedly to systematize the methodology and address the drawbacks.…”

“…The use of either method depends on a combination of two factors (i) the ability of the biomarker to be retained in a cartridge and (ii) the concentration of biomarker found in wastewater. For example, illicit drugs and pharmaceuticals are usually extracted by SPE [ 32 , 34 , 37 , 95 ] while alcohol (ethyl sulphate) is determined by direct injection [ 46 , 47 , 49 , 51 ] (see Table 1 for more exhaustive examples).…”

“…FEV: 100 μL GC-MS (derivatization with MBTFA HP-1 (30 m × 0.25 mm × 0.25 μm) 253 Appropriate [ 53 ] Nicotine Cotinine Nicotine 50 mL pH near 7 HLB SPE and elution with MeOH. FEV: 500 μL LC-QqQ-MS/MS ESI (+) Allure PFPP (50 × 2.1 mm, 5 μm) and H 2 O 0.1% NH 4 F. and MeOH at 0.4 mL/min 300 Appropriate [ 51 ] Caffeine 1,7-dimethyluric acid 3 mL pH near 7 HLB SPE and elution with MeOH. FEV: 100 μL LC-QqQ-MS/MS (QTRAP) ESI (+) Separation not described – Appropriate [ 52 ] Caffeine Caffeine 3 mL pH near 7 PEP-2 SPE and elution with methanol.…”

“…And AcN at 0.180 mL/min 1000 Appropriate [ 49 ] Alcohol Ethyl sulphate Centrifuged at 3500 rpm for 10 min, 190 μL filtered through 0.22 μm and 10 μL injected. LC-QqQ-MS/MS ESI (−) Allure PFPP (50 × 2.1 mm, 5 μm) and H 2 O 0.1% NH 4 F. and MeOH at 0.4 mL/min 300 Appropriate [ 51 ] Artificial sweeteners cyclamate, acesulfame, sucralose, saccharin, aspartame, neotame and neohesperidin dihydrochalcone Filtration through RC 0.22 μm and injection of 6 μL. LC-QqQ-MS/MS ESI (+) Luna Omega Polar C18 100 Å (50 × 2.1 mm, 1.6 μm) and H 2 O 0.1% FA and AcN at 0.3 mL/min 50–950 Appropriate [ 44 ] Artificial sweeteners Sucralosa acesulfame Direct injection, sample treatment prior to injection, not specified, volume injected not specified LC-QqQ-MS/MS ESI (+) Other conditions not specified 2–20 Appropriate [ 45 ] Pharmaceuticals 168 pharmaceuticals and metabolites 50 mL treated with EDTA, prepared in duplicated and adjusted at pH 2 and 7 Waters Oasis HLB, Agela Cleanert PEP-2, and CNW Poly-Sery HLB SPE were tested and elution with 4 mL of MeOH.…”

“…Most of the chromatography is a reverse phase chromatography that applies the ultra-high performance liquid chromatography (UHPLC) columns of 1.7 μm. The stationary phases are mostly C18 but as most of the analytes are very polar, there are other phases such as biphenyl [ 14 , 32 , 34 , 40 , 42 , 47 , 63 , 80 , 81 ] or pentafluoropropyl (PFP or F5) [ 41 , 51 , 86 ] also frequently used. The mobile phases are mostly water with formic or acetic acids or with volatile salts, such as ammonium formate, acetate, etc., methanol and acetonitrile.…”